0208-077 (RR)LICENSED CONTRACTOR: DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License k I Lic. Class Exp. Date
235717 C-39 B HIC 1/31/03
Date Signature of Contractor
OWNER=BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following r'ea'son:
( ) I, as,owner of the property, or my employees with wages as their sole
compensation, willdo, the work, and the structure is not intended or offered for
sale (Sec. 7044; Business & Professionals Code).
( ) = 1, as owner of the property, am exclusively contracting .with licensed
contractors, -to- construct-th& project- (Sec: 7044•, -Business., Professionals
Code).
( )y I am exempt under Section "`•,;B&P C. for this reason
Date Signature of Owner.
VIIORKER'S COMPENSATION DECLARATION
I,h.ereby affirm., under penalty of perlury.-one of..the folio wind' declarations:
O I•have and,will rnaintaln:a certificate of.consentlo self-insure'for workers'
"compensation =;as provided for by Section' 3700of°the Labor Code,' for'the
-,performance of>the work:for which this permit Is Issued.
( ) I have and will maintain workers ;compensation insurance, as required by
Section'3700 of. the Labor Code, for the performanceof the.work;